Camille E. Powe, MD, a Mass General Brigham endocrinologist, specializes in treating diabetes in pregnancy. Dr. Powe co-directs the Diabetes in Pregnancy Program at Massachusetts General Hospital. She also conducts clinical research on the genetics and physiology of metabolic disease in pregnancy.
In this Q&A, Dr. Powe reflects on how the program’s personalized, integrated, and innovative approach ensures patients receive the most advanced diabetes care available.
Powe: The Mass General Diabetes in Pregnancy Program has three unique features that set us apart.
The first is that it is truly integrative and collaborative. We have endocrine, maternal-fetal medicine, nutrition, and ultrasound specialists all in one place. This makes it easy for all of the different medical providers to connect on individual cases and to work together to come up with the best medical treatment plan for a patient. Our integrated, co-located care model also makes things much more convenient for patients.
The second unique feature is that our program is innovative. We were early adopters of telemedicine before it was popularized. We use both video visits and email-based visits to connect with patients for frequent follow-up. We also take advantage of all advanced diabetes technologies. These include: continuous glucose monitoring, connected glucometers, apps, smart insulin pens, and the latest insulin pumps. We make sure our patients get the latest and greatest tools to help care for diabetes.
The third feature is that it’s extremely personalized. We treat each unique patient with an individualized plan that recognizes that all diabetes is not the same.
Powe: Every type of diabetes is different and every person with diabetes is unique. Currently, most treatment for diabetes in pregnancy has a one-size-fits-all approach. Both in our clinical care and research, we are constantly pushing against this. For example, many people don’t realize that individual people can have very different blood sugar responses to the same foods.
In the clinical realm, we provide each patient with a personalized nutrition consultation with a dietician who has extensive expertise in both pregnancy and diabetes. They help develop an individualized meal plan that is responsive to the patient’s blood sugars. In the research realm, we’re doing a study using continuous glucose monitoring to test breakfasts with different amounts of protein and fat to see if we can get better at giving personalized dietary advice.
We look at each patient’s case and make sure that they have the right “type” of diabetes diagnosis. It is not uncommon for us to find that people have genetic forms of diabetes that have been misdiagnosed before pregnancy. We always think about this possibility and can arrange genetic testing in these cases.
Powe: The goal of our research program is to bring all of the advances in diabetes diagnosis and therapeutics from the last decade to pregnant women, who are often left out of clinical studies. Our studies primarily focus on physiology, genetics, and technology.
Powe: The biggest and most exciting study we are involved in right now is called GO MOMs. It’s very exciting because more than 2,000 pregnant individuals from across the country will join the study. They’ll wear continuous glucose monitors and give blood samples four times over the course of their pregnancy.
Continuous glucose monitors give us 288 glucose readings each day, more than any other way of tracking blood sugar. We’ll look at how these blood sugar profiles relate to traditional gestational diabetes diagnosis and baby birth weights.
The study is expected to revolutionize the way we diagnose gestational diabetes. In addition to GO MOMs, we have several smaller studies focused on nutrition, genetics, blood sugar, and insulin changes in pregnancy.
Powe: We expect our research to change the face of diabetes in pregnancy care so that pregnant patients benefit from all of the latest advances in diabetes research. Many times pregnant and lactating people are excluded from clinical studies. Because of this, they are the last to get the benefits from new discoveries.
We believe this is wrong and we are working hard to change it. Because Mass General Brigham has so much cutting-edge diabetes research and we are passionate about maternal health, in our Diabetes in Pregnancy Program we prioritize ensuring that our patients are already benefitting from every innovation that we have to offer them.
Powe: In the future, I believe that each person who comes into pregnancy with a diabetes diagnosis, or who is diagnosed with gestational diabetes, will have their unique hormonal and genetic profile analyzed. This will help us develop care plan options for treating their diabetes in pregnancy, leveraging all available technologies. In concert with this, each patient will have a group of doctors and other providers that will respectfully put this profile in the context of each person’s daily life habits, values, personal challenges, and structural barriers, to make sure that the care plan is successful.